Chapter 30 Flashcards
- When caring for a pregnant woman with cardiac problems, the nurse must be alert for the signs and symptoms of cardiac decompensation. Which critical findings would the nurse find on assessment of the client experiencing this condition?
a. Regular heart rate and hypertension
b. Increased urinary output, tachycardia, and dry cough
c. Shortness of breath, bradycardia, and hypertension
d. Dyspnea, crackles, and an irregular, weak pulse
ANS: D
Signs of cardiac decompensation include dyspnea; crackles; an irregular, weak, and rapid pulse; rapid respirations; a moist and frequent cough; generalized edema; increasing fatigue; and cyanosis of the lips and nailbeds. A regular heart rate and hypertension are not generally associated with cardiac decompensation. Of the symptoms of increased urinary output, tachycardia, and dry cough, only tachycardia is indicative of cardiac decompensation. Of the symptoms of shortness of breath, bradycardia, and hypertension, only dyspnea is indicative of cardiac decompensation.
- Which condition would require prophylaxis to prevent subacute bacterial endocarditis (SBE) both antepartum and intrapartum?
a. Valvular heart disease
b. Congestive heart disease
c. Arrhythmias
d. Postmyocardial infarction
ANS: A
Prophylaxis for intrapartum endocarditis and pulmonary infection may be provided for women who have mitral valve prolapse. Prophylaxis for intrapartum endocarditis is not indicated for a client with congestive heart disease, underlying arrhythmias, or postmyocardial infarction.
- Which information should the nurse take into consideration when planning care for a postpartum client with cardiac disease?
a. The plan of care for a postpartum client is the same as the plan for any pregnant woman.
b. The plan of care includes rest, stool softeners, and monitoring of the effect of activity.
c. The plan of care includes frequent ambulating, alternating with active range-of-motion exercises.
d. The plan of care includes limiting visits with the infant to once per day.
ANS: B
Bed rest may be ordered, with or without bathroom privileges. Bowel movements without stress or strain for the woman are promoted with stool softeners, diet, and fluids. Care of the woman with cardiac disease in the postpartum period is tailored to the woman’s functional capacity. The woman will be on bed rest to conserve energy and to reduce the strain on the heart. Although the woman may need help caring for the infant, breastfeeding and infant visits are not contraindicated.
- A woman has experienced iron deficiency anemia during her pregnancy. She had been taking iron for 3 months before the birth. The client gave birth by cesarean 2 days earlier and has been having problems with constipation. After assisting her back to bed from the bathroom, the nurse notes that the woman’s stools are dark (greenish-black). What should the nurse’s initial action be?
a. Perform a guaiac test, and record the results.
b. Recognize the finding as abnormal, and report it to the primary health care provider.
c. Recognize the finding as a normal result of iron therapy.
d. Check the woman’s next stool to validate the observation.
ANS: C
The nurse should recognize that dark stools are a common side effect in clients who are taking iron replacement therapy. A guaiac test would be indicated if gastrointestinal (GI) bleeding was suspected. GI irritation, including dark stools, is also a common side effect of iron therapy. Observation of stool formation is a normal nursing activity.
- A woman with asthma is experiencing a postpartum hemorrhage. Which drug should be avoided when treating postpartum bleeding to avoid exacerbating asthma?
a. Oxytocin (Pitocin)
b. Nonsteroidal antiinflammatory drugs (NSAIDs)
c. Hemabate
d. Fentanyl
ANS: C
Prostaglandin derivatives should not be used to treat women with asthma, because they may exacerbate symptoms. Oxytocin is the drug of choice to treat this woman’s bleeding; it will not exacerbate her asthma. NSAIDs are not used to treat bleeding. Fentanyl is used to treat pain, not bleeding.
- Which important component of nutritional counseling should the nurse include in health teaching for a pregnant woman who is experiencing cholecystitis?
a. Assess the woman’s dietary history for adequate calories and proteins.
b. Teach the woman that the bulk of calories should come from proteins.
c. Instruct the woman to eat a low-fat diet and to avoid fried foods.
d. Instruct the woman to eat a low-cholesterol, low-salt diet.
ANS: C
Eating a low-fat diet and avoiding fried foods is appropriate nutritional counseling for this client. Caloric and protein intake do not predispose a woman to the development of cholecystitis. The woman should be instructed to limit protein intake and choose foods that are high in carbohydrates. A low-cholesterol diet may be the result of limiting fats. However, a low-salt diet is not indicated.
- Postoperative care of the pregnant woman who requires abdominal surgery for appendicitis includes which additional assessment?
a. Intake and output (I&O) and intravenous (IV) site
b. Signs and symptoms of infection
c. Vital signs and incision
d. Fetal heart rate (FHR) and uterine activity
ANS: D
Care of a pregnant woman undergoing surgery for appendicitis differs from that for a nonpregnant woman in one significant aspect: the presence of the fetus. Continuous fetal and uterine monitoring should take place. An assessment of I&O levels, along with an assessment of the IV site, are normal postoperative care procedures. Evaluating the client for signs and symptoms of infection is also part of routine postoperative care. Routine vital signs and evaluation of the incision site are expected components of postoperative care.
- Since the gene for cystic fibrosis was identified in 1989, data can be collected for the purposes of genetic counseling for couples regarding carrier status. According to the most recent statistics, how often does cystic fibrosis occur in Caucasian live births?
a. 1 in 100
b. 1 in 1000
c. 1 in 2000
d. 1 in 3200
ANS: D
Cystic fibrosis occurs in approximately 1 in 3200 Caucasian live births. 1 in 100, 1 in 1000, and 1 in 2000 occurrences of cystic fibrosis in live births are all too frequent rates.
- Which information regarding the care of antepartum women with cardiac conditions is most important for the nurse to understand?
a. Stress on the heart is greatest in the first trimester and the last 2 weeks before labor.
b. Women with class II cardiac disease should avoid heavy exertion and any activity that causes even minor symptoms.
c. Women with class III cardiac disease should get 8 to 10 hours of sleep every day and limit housework, shopping, and exercise.
d. Women with class I cardiac disease need bed rest through most of the pregnancy and face the possibility of hospitalization near term.
ANS: B
Class II cardiac disease is symptomatic with ordinary activity. Women in this category need to avoid heavy exertion and limit regular activities as symptoms dictate. Stress is greatest between weeks 28 and 32 of gestation, when hemodynamic changes reach their maximum. Class III cardiac disease is symptomatic with less-than-ordinary activity. These women need bed rest most of the day and face the possibility of hospitalization near term. Class I cardiac disease is asymptomatic at normal levels of activity. These women can perform limited normal activities with discretion, although they still need a good amount of sleep.
- A woman at 28 weeks of gestation experiences blunt abdominal trauma as the result of a fall. The nurse must closely observe the client for what?
a. Alteration in maternal vital signs, especially blood pressure
b. Complaints of abdominal pain
c. Placental absorption
d. Hemorrhage
ANS: C
Electronic fetal monitoring (EFM) tracings can help evaluate maternal status after trauma and can reflect fetal cardiac responses to hypoxia and hypoperfusion. Signs and symptoms of placental absorption include uterine irritability, contractions, vaginal bleeding, and changes in FHR characteristics. Hypoperfusion may be present in the pregnant woman before the onset of clinical signs of shock. EFM tracings show the first signs of maternal compromise, such as when the maternal heart rate, blood pressure, and color appear normal, yet the EFM printout shows signs of fetal hypoxia. Abdominal pain, in and of itself, is not the most important symptom. However, if it is accompanied by contractions, changes in the FHR, rupture of membranes, or vaginal bleeding, then the client should be evaluated for abruptio placentae. Clinical signs of hemorrhage do not appear until after a 30% loss of circulating volume occurs. Careful monitoring of fetal status significantly assists in maternal assessment, because the fetal monitor tracing works as an oximeter of internal well-being.
- Which neurologic condition would require preconception counseling, if at all possible?
a. Eclampsia
b. Bell palsy
c. Epilepsy
d. Multiple sclerosis
ANS: C
Women with epilepsy should receive preconception counseling, if at all possible. Achieving seizure control before becoming pregnant is a desirable state. Medication should also be carefully reviewed. Eclampsia may sometimes be confused with epilepsy, and Bell palsy is a form of facial paralysis; preconception counseling for either condition is not essential to care. Multiple sclerosis is a patchy demyelination of the spinal cord that does not affect the normal course of pregnancy or birth.
- The client makes an appointment for preconception counseling. The woman has a known heart condition and is unsure if she should become pregnant. Which is the only cardiac condition that would cause concern?
a. Marfan syndrome
b. Eisenmenger syndrome
c. Heart transplant
d. Ventricular septal defect (VSD)
ANS: B
Pregnancy is contraindicated in clients with Eisenmenger syndrome. Women who have had heart transplants are successfully having babies. However, conception should be postponed for at least 1 year after transplantation. Management of the client with Marfan syndrome during pregnancy includes bed rest, beta-blockers, and surgery before conception. VSD is usually corrected early in life and is therefore not a contraindication to pregnancy.
- What form of heart disease in women of childbearing years generally has a benign effect on pregnancy?
a. Cardiomyopathy
b. Rheumatic heart disease
c. Congenital heart disease
d. Mitral valve prolapse
ANS: D
Mitral valve prolapse is a benign condition that is usually asymptomatic. Cardiomyopathy produces congestive heart failure during pregnancy. Rheumatic heart disease can lead to heart failure during pregnancy. Some congenital heart diseases produce pulmonary hypertension or endocarditis during pregnancy.
- A pregnant woman at 33 weeks of gestation is brought to the birthing unit after a minor automobile accident. The client is experiencing no pain and no vaginal bleeding, her vital signs are stable, and the FHR is 132 beats per minute with variability. What is the nurse’s highest priority?
a. Monitoring the woman for a ruptured spleen
b. Obtaining a physician’s order to discharge her home
c. Monitoring her for 24 hours
d. Using continuous EFM for a minimum of 4 hours
ANS: D
Monitoring the external FHR and contractions is recommended after blunt trauma in a viable gestation for a minimum of 4 hours, regardless of injury severity. Fetal monitoring should be initiated as soon as the woman is stable. In this scenario, no clinical findings indicate the possibility of a ruptured spleen. If the maternal and fetal findings are normal, then EFM should continue for a minimum of 4 hours after a minor trauma or a minor automobile accident. Once the monitoring has been completed and the health care provider is reassured of fetal well-being, the client may be discharged home. Monitoring for 24 hours is unnecessary unless the ERM strip is abnormal or nonreassuring.
- Bell palsy is an acute idiopathic facial paralysis, the cause for which remains unknown. Which statement regarding this condition is correct?
a. Bell palsy is the sudden development of bilateral facial weakness.
b. Women with Bell palsy have an increased risk for hypertension.
c. Pregnant women are affected twice as often as nonpregnant women.
d. Bell palsy occurs most frequently in the first trimester.
ANS: B
The clinical manifestations of Bell palsy include the development of unilateral facial weakness, pain surrounding the ears, difficulty closing the eye, and hyperacusis. The cause is unknown; however, Bell palsy may be related to a viral infection. Pregnant women are affected at a rate of three to five times that of nonpregnant women. The incidence rate peaks during the third trimester and puerperium. Women who develop Bell palsy in pregnancy have an increased risk for hypertension.
